Federal government websites often end in .gov or .mil. The https:// ensures that you are connecting to the HHS Vulnerability Disclosure, Help Nascimento Junior JAC, Santos AM, Oliveira AMS, Guimares AG, Quintans-Jnior LJ, Coutinho HDM, Martins N, Borges LP, Serafini MR. Front Public Health. On the other hand, either diet composition, meal frequency or eating time, all can influence GH, prolactin, and cortisol levels (57). Conclusions: Clinical laboratory should make efforts to reduce pre-analytical errors in order to report accurate and expeditious results. Toward optimal laboratory use: problems in laboratory testing in primary care. The .gov means its official. Narula, A., Yadav, S., Jahan, A., Verma, A., Katyal, A., Anand, P., Pruthi, S., Sarin, N., Gupta, R. and Singh, S. (2019) Pre-analytical error in a hematology laboratory: an avoidable cause of compromised quality in reporting. However, should be centrifuged within 2 h after blood collection. Thus, provocative tests of GH secretion using appropriate stimuli are employed to test for GH deficiencies (GHD). Errors in the Hematology Laboratory at St. Paul's Hospital Millennium sharing sensitive information, make sure youre on a federal Sources of errors in hematology testing - ScienceDirect Prolactin is another hormone with diurnal variation and with higher levels at night (74). Lima-Oliveira G, Salvagno GL, Lippi G, Brocco G, Voi M, Montagnana M, Picheth G, Guidi GC. Common Pre-Analytical Errors in the Lab | Stenberg College MeSH Lippi G, Salvagno GL, Danese E, Lima-Oliveira G, Brocco G, Guidi GC. The following immunoassays: ferritin, TSH, Vitamin B12, progesterone and folic acid, all showed variable degrees of interference. Restituto P, Galofre JC, Gil MJ, Mugueta C, Santos S, Monreal JI, Varo N. Advantage of salivary cortisol measurements in the diagnosis of glucocorticoid related disorders, Measurement of late-night salivary cortisol and cortisone by LC-MS/MS to assess preanalytical sample contamination with topical hydrocortisone. Pant Hospital. Bethesda, MD 20894, Web Policies Types and Frequencies of Pre-Analytical Errors in the Clinical GH stimulation tests use a defined cut-off concentration for peak GH to distinguish deficient from non-deficient GH subjects. Comparison of different methods to determine intrathecal synthesis, Reference interval by the indirect approach of serum thyrotropin (TSH) in a Mediterranean adult population and the association with age and gender, Next-generation reference intervals for pediatric hematology, Preliminary evaluation of a new flow cytometry method for the routine hematology workflow, Utility of procalcitonin for differentiating cryptogenic organising pneumonia from community-acquired pneumonia, A high C-reactive protein/procalcitonin ratio predicts, Evaluation of reference change values for a hs-cTnI immunoassay using both plasma samples of healthy subjects and patients and quality control samples, Outlier removal methods for skewed data: impact on age-specific high-sensitive cardiac troponin T 99th percentiles, Comparison of precision and operational performances across six immunochemistry analyzers, Evaluation of the possible interference of abiraterone therapy on testosterone immunoassay, Erroneous thyroid and steroid hormones profile due to anti-streptavidin antibodies, Reference values for 24,25-dihydroxyvitamin D and the 25-hydroxyvitamin D/24,25-dihydroxyvitamin D ratio, Stability of tubular damage markers epidermal growth factor and heparin-binding EGF-like growth factor in urine, Blood from heparin tubes is an acceptable alternative to assess hematocrit determination. official website and that any information you provide is encrypted The most common preanalytical variables (Figure 1) could be classified in: Preanalytical sources of laboratory interferences. When analyzing biological samples such as serum or plasma (usual laboratory matrices), interferences are also possible due to similar compounds, such as other proteins presenting like epitopes ( 1 ). Individuals affected by Cushings syndrome show incongruously high ACTH and cortisol levels during late night hours. Laboratory sampling. Lippi G, Lima-Oliveira G, Nazer SC, Moreira ML, Souza RF, Salvagno GL, Montagnana M, Scartezini M, Picheth G, Guidi GC. eCollection 2014. Pre analytical errors in the clinical laboratory and how to minimize them. Preanalytical management: serum vacuum tubes validation for routine clinical chemistry. Upreti S, Upreti S, Bansal R, Jeelani N, Bharat V. Types and frequency of preanalytical errors in haematology lab. It appears due to SST adsorption of some CRP macromolecules that form complexes with SST gel (84). Melatonin marks circadian phase position and resets the endogenous circadian pacemaker in humans. These errors were overwhelmingly more common in inpatients than in outpatients. doi: 10.1371/journal.pone.0230532. PubMed Central, 9. Kisspeptins (Kps) are peptide hormones, generators of both sex steroid negative and positive feedback signals for GnRH secretion in male and female at puberty, preserve male fertility, and govern the pre-ovulatory LH surge in females (35). 4. -, Green SF. Nunez SB, Municchi G, Barnes KM, Rose SR. Insulinlike growth factor I (IGF-I) and IGF-binding protein-3 concentrations compared to stimulated and night growth hormone in the evaluation of short children--a clinical research center study. Conclusion: Of all the samples received in the lab, the overall percentage of rejection is 1.52%. Bajaa W, Aranda E, Arredondo ME, Brennan-Bourdon LM, Campelo MD, Espinoza E, Flores S, Ochoa P, Vega V, Varela B, Lima-Oliveira G. Impact of an Andean breakfast on biochemistry and immunochemistry laboratory tests: an evaluation on behalf COLABIOCLI WG-PRE-LATAM. High concentrations of paraproteins can interfere with various laboratory immunoassays, and laboratory personnel should be aware of this when the laboratory findings are discordant with the clinical findings (45). Unauthorized use of these marks is strictly prohibited. Identification of the types of preanalytical errors in the clinical chemistry laboratory: 1-year study at G.B. Lam L, Bagg W, Smith G, Chiu WW, Middleditch MJ, Lim JC, Kyle CV. Well-written laboratory testing procedures, validation of laboratory instruments and assays, strong quality control programs, and proper education and training of laboratory professionals are practices that will decrease . Lima-Oliveira G, Lippi G, Salvagno GL, Gaino S, Poli G, Gelati M, Picheth G, Guidi GC. Quality management of preanalytical phase: impact of lithium heparin vacuum tubes changes on clinical chemistry tests. As regards RF, falsely elevated results were reported in serum (but not in plasma) samples spiked with patient RF pool when vancomycin immune assays were performed (49). English E, McFarlane I, Taylor KP, Halsall DJ. Please login or register with De Gruyter to order this product. Clin Chem. The site is secure. Besides, there are physiological variables, as follows: circadian rhythm, seasonal influences, environmental influences, exercise, posture, and pregnancy. Stress causes variations, as it influences GH, prolactin, Cortisol and the total/free ratio of thyroid hormone. Chawla R, Goswami B, Tayal D, Mallika MD. 2011 Jun;43(4):346-9. doi: 10.1097/PAT.0b013e32834634f4. Moreover, serum concentrations of thyroid hormones are reportedly different between males and females and for age groups in white children/adolescents (28). The major source of errors in laboratories occurs in the preanalytical phase, with over 46% to 68%. Laboratory professionals routinely identify pre-analytical errors and take corrective measures. McTiernan A, Wu L, Chen C, Chlebowski R, Mossavar-Rahmani Y, Modugno F, Perri MG, Stanczyk FZ, Van Horn L, Wang CY; Womens Health Initiative Investigators. National Library of Medicine Plasma samples should be stored at +4C and analyzed within 72 h from collection (77). e262-e264. reported interferences on resistin and myeloperoxidase immunosorbent assays from BioVendor. The preanalytical phase is the major source of laboratory variability. Clin Chem Lab Med. The overall rate of pre-analytical errors was 0.40%. PDF Pre-analytical Errors in The Clinical Laboratory and How to Minimize Them -, Lippi G. Governance of preanalytical variability: Travelling the right path to the bright side of the moon? Indian J Clin Biochem 2009;24:35660.10.1007/s12291-009-0064-4Search in Google Scholar Suitability of a transport box for blood sample shipment over a long period. Note: Results are presented as mean volume from five evacuated tubes producers BD Vacutainer, Becton, Dickinson and Company; Vacuette, Greiner Bio-One; Vacumed, FL Medical; Vacutest, Kima; and S-Monovette, Sarstedt using the vacuum technique filled with a solution with density and viscosity like whole blood. Discrepancies have been observed in C-reactive protein (CRP) assays measured in serum samples from SST tubes, in particular lower values in SST serum than in serum from plain tubes. Your purchase has been completed. The main hormone that determines the height growth at each stage of development is growth hormone (GH), together with its mediator, insulin-like growth factor 1 (IGF-1). PubMed, 6. It is recommended that blood samples for PTH measurement should be taken, ideally between 10:00 and 16:00, and plasma separated within 24 h of blood collection. PDF Pre and postanalytical errors in haematology - Fondation Mrieux An official website of the United States government. 2023 Jan 10;11:20503121221148062. doi: 10.1177/20503121221148062. The site is secure. 2020 Oct 27;8:563095. doi: 10.3389/fpubh.2020.563095. Clipboard, Search History, and several other advanced features are temporarily unavailable. Regarding pituitary function, some physiological variables can induce modifications to the pituitary secretion, as follows: age, travel (that influences both pituitary and adrenal functions), circadian rhythm and pulsatile release, seasonal influences, environmental influences, exercise, stress, and posture (3). Atay A, Demir L, Cuhadar S, Saglam G, Unal H, Aksun S, Arslan B, Ozkan A, Sutcu R. Biochem Med (Zagreb). Thus, this study was designed with the following objectives: (i) to determine and compare the blood specimen rejection rate of a clinical laboratory and (ii) to characterise and compare the types of preanalytical errors between the pre-pandemic and the pandemic phases. To increase accuracy, testosterone in men should be measured with a fasting morning sample and repeated if the level is found to be low; in women, the laboratory must perform the measurements at the follicular phase of the cycle. Here are the types of errors which most commonly occur: Before specimen collection: Patient is misidentified, specimen tubes are incorrectly labeled or aren't labeled at all, patient did not follow proper procedures before test (such as fasting). Pre-analytical errors damage an institution's reputation, diminish confidence in healthcare services, and contribute to a significant increase in the total operating costs, both for the hospital and laboratory. Errors in a stat laboratory: types and frequencies 10 years later. Moreover, habitual coffee intake is related to effects on either glycerophospholipid metabolism (64) or several metabolic pathways (65). The majority of errors (32-75%) occur before the sample is analyzed: During labeling, collection, transport or centrifugation. 2004 Dec 1;88(3):161-81. doi: 10.1002/jso.20125. SARS-CoV-2; laboratory biosafety; preanalytical phase; quality indicators; total testing process. Progesterone levels decreased with increasing lipemia. The https:// ensures that you are connecting to the Cortisol can be assayed either in serum or in saliva (70). Moreover IGF-I concentrations are reduced in malnourished children, and/or with hypothyroidism, chronic disease, renal failure and diabetes (37). Through root cause analysis, we identified hemolysis of laboratory specimens as the most common cause of rejected specimens (Table 3). Upreti S, Upreti S, Bansal R, Jeelani N, Bharat V. Types and frequency of preanalytical errors in haematology lab. The immunoassays methods need avoiding interferences that can influence result interpretation. When collecting saliva samples, it is important to instruct the patient to avoid hydrocortisone containing creams or ointments in order to prevent analytical interference (72). Clinical Chemistry and Laboratory Medicine (CCLM), Vol. We acknowledge Australian Aboriginal People and Torres Strait Islander People as the first inhabitants of the nation, and acknowledge Traditional Owners of the lands where our staff and students live, learn and work. J Am Med Assoc 1996;275:6359.10.1001/jama.275.8.635Search in Google Scholar, 5. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, the interference of heterophile antibody affecting fT4 Roche immunoassay, indicating a suspect hyperthyroidism which revealed false after retesting on another platform (Centaur, Siemens) (, cases of anti-streptavidin antibodies mimicking heterophilic antibodies in thyroid tests (, cases of apparent hyperthyroidism due to Biotin-like interference from IgM anti-streptavidin, a pattern that mimics the excess biotin ingestion (. The reasonable cause for these divergences was ascribed to interaction between blood and components in the evacuated tubes, e.g. Besides a true hyperprolactinemia, elevated morning levels can be due to stress conditions, medications or spurious hyperprolactinemia. Main sources of interference arise from either patient status, preparation and physiology or laboratory process and procedures. Esposito S, Leonardi A, Lanciotti L, Cofini M, Muzi G, Penta L. Vitamin D and growth hormone in children: a review of the current scientific knowledge, Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence. Reducing the occurrence of errors in a laboratory's specimen receiving ferritin, TSH, Vitamin B12, progesterone and folic acid. Adding to the above issues, clinical laboratories should be aware of preanalytical problems that are particularly relevant when dealing with the immunoassays. Your documents are now available to view. Serum IGF-I concentrations vary with age and it must be considered that the normal range for serum IGF-I concentrations in young children superimposes on the range observed in children with GH deficiency. J Clin Diagn Res: JCDR 2013;7:24913. Causes of Preanalytical Interferences on Laboratory Immunoassays - A Product Catalogue, Performance of evacuated blood collection tubes at high altitude, Impact of evacuated collection tube fill volume and mixing on routine coagulation testing using 2.5-ml (pediatric) tubes, http://creativecommons.org/licenses/by-nc/4.0/, https://www.bd.com/resource.aspx?IDX=10155, https://www.gbo.com/fileadmin/user_upload/1729004RN_Joint_Catalog_2017_Web.pdf, https://www.sarstedt.com/fileadmin/user_upload/Katalog/2019/45_200_catalogue_en_eu_eu_2019_2020_hp.pdf. An Overview and Approach to Preventing Pre-Analytical Errors - LabLeaders Diagnosis (Berl). This phase includes all those steps that occur in the practice such as specimen collection, handling, storage and shipping to the laboratory. Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause, Andropause--lessons from the European Male Ageing Study, Thyroid Function in Aging: A Discerning Approach, Novel aspects of the endocrinology of the menstrual cycle, Cardiovascular Implications of the Menopause Transition: Endogenous Sex Hormones and Vasomotor Symptoms. An official website of the United States government. Disclaimer. Measurement of serum testosterone level is important for the assessment of hypogonadism in men and androgen excess in women, where it vary mainly according to the phase of the menstrual cycle. Asia Pac J Health Sci 2017;4:46. Introduction: Lewandowski KC, Skowronska-Jozwiak E, Szosland K, Lewinski A. Different laboratory results, including hormones, were reported using different brands of serum- and plasma-evacuated tubes (13, 78, 79). Pre-analytical errors can occur at any point during the specimen collection process. Dr. Ravi Gaur (Director & Chair Medical Advisory Committee, Oncquest laboratories Ltd) shares his expertise and suggests-, Quality is never an accident. 8600 Rockville Pike Pre-analytical errors: their impact and how to minimize them Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. Federal government websites often end in .gov or .mil. Serei VD, Marshall I, Carayannopoulos MO. In both cases, borderline results may be clarified by the assessment of free testosterone. Would you like email updates of new search results? Chawla R, Goswami B, Tayal D, Mallika MD. Lippi G, Guidi GC, Mattiuzi C, Plebani M. Preanalytical variability: the dark side of the moon in laboratory testing. No interference was observed due to hemolysis and icterus on Syva EMIT and DRI assay, whereas interference was marked on Roche assays; whereas lipemia was less evident on Roche than on Syva EMIT and DRI assay (22). Clipboard, Search History, and several other advanced features are temporarily unavailable. Iran J Pathol 2016;11:1514. Accessibility Lipemia did not show any interference (21). There are many such finer things, and which are overlooked several times which further can lead to testing errors. There are some preanalytical issues to be considered: i) rapid degradation is observed in serum, therefore sample must be processed immediately after collection (freezing-thawing does not significantly affect results); ii) either heparin with 2000 U trasylol or EDTA should be used as anticoagulant, whereas citrate causes lowering of results.
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